Making Companies Pay

IN 13 STATES, INSURERS ARE REQUIRED by law to offer some form of infertility coverage, according to American Society for Reproductive Medicine. Massachusetts has among the most aggressive laws, requiring coverage for even the most advanced infertility treatments.

A 1998 study of insurance costs in Massachusetts concluded that mandated infertility coverage added less than $25 a year to the cost of each insurance policy. "Comprehensive coverage is the only fair way to go," says Diane Aronson, the head of the national infertility support group, Resolve, which pushed without success this year for Congress to require companies to cover the condition.

Insurers and employers object to mandates. Richard Coorsh, spokesman for the Health Insurance Association of America, says the nation is a patchwork of state insurance laws, which all boost the cost to consumers. "Once you start adding these things up, the mandates, no matter how well intended, raise the number of the uninsured. And the key goal should be to lower the number of uninsured," Coorsh says.

In general, state mandates do not cover companies that create their own "self-insurance pool," and those are the majority.

If it weren't for the Massachusetts law, Boston resident Mary Michele Delaney figures she would never have given birth to a child. Mary is an expert on employee benefits, her husband, Eamon, is a construction contractor. It took them 13 artificial insemination attempts and three IVFs to achieve their baby boy, Joshua, born last winter. Health insurance covered all the costs, which the couple estimates at $150,000 or more.

"We're extremely lucky to live in a state that covers this," Mary says.

Though the Delaneys are comfortably upper-middle-class, they say they could never have kept trying for a biological child as long as they did. Instead, they probably would have adopted - itself an expensive project, and not always the right solution for couples with intractable infertility, Mary says.

"It isn't just a bummer when you can't have kids," Mary says. "It's a serious disease."

Click image to go to Pamela's Album

Pamela and son Tyler during a day of apple picking.

In New York, Pamela Madsen has taken on the cause as her profession. She is head of the New York City chapter of Resolve, helping lead an effort to toughen the state's existing insurance mandate. The current law requires insurers to pay for diagnosis and certain treatments, but does not obligate the companies to pay for IVF.

Madsen rejects the argument that covering advanced procedures will make basic health insurance unaffordable to New Yorkers. "I certainly think that $2.50 a year - the price of a bagel and cup of coffee - is worth a child."